title: Effects of hormonal contraceptive use on HIV acquisition and transmission among HIV-discordant couples.
abstract: BACKGROUND
  The risk of HIV associated with hormonal contraceptives is controversial. We assessed hormonal contraceptive use and HIV incidence in HIV-discordant couples in Rakai, Uganda.
  
  
  METHODS
  HIV-discordant couples were retrospectively identified from a cohort between 1999 and 2009. Hormonal contraception included oral contraception, depomedroxyprogesterone acetate (DMPA), and implants (Norplant). Poisson regression estimated adjusted incidence rate ratios (adjIRRs) associated with hormonal contraceptive methods. A case-control subanalysis estimated odds ratios (ORs) of HIV associated with hormonal contraceptive, adjusted for viral load and age.
  
  
  RESULTS
  We identified 190 male HIV-positive/female HIV-negative (M+F-) and 159 male HIV- negative/female HIV-positive (M-F+) couples not using antiretroviral therapy or condoms. Female HIV incidence was 5.8/100 person-years (py) among nonhormonal contraceptive users, 12.0/100 py among oral contraceptive users [adjIRR 2.65, 95% confidence interval (CI) 0.82-8.60], 4.5 among Norplant users (adjIRR: 0.89, 95% CI 0.11-7.10), and 7.5/100 py among DMPA users (adjIRR 1.42, 95% CI 0.60-3.36). Male HIV incidence was 7.4/100 py during nonhormonal contraceptive use, 16.5/100 py during female oral contraceptive use (adjIRR 2.52, 95% CI 0.49-12.95), and 4.9/100 py with DMPA use (adjIRR 0.57, 95% CI 0.19-1.70). The number of female seroconverters was three among oral contraceptive users, one among Norplant users, and seven among DMPA users. Male seroconverters were two during female oral contraceptive use, none with Norplant use, and three with DMPA use. In a nested case-control analysis after adjustment for HIV viral load, the adjOR associated with oral contraceptive use was 1.59 (95% CI 0.32-97.85) for M+F- and 2.11 (95% CI 0.18-25.26) for M-F+ couples. For DMPA use, the adjOR was 1.44 (95% CI 0.46-4.51) for M+F- and 1.40 (95% CI 0.30-6.49) for M-F+ couples.
  
  
  CONCLUSIONS
  We did not observe significant risk of HIV acquisition or transmission with oral contraceptives or DMPA use in HIV discordant couples, but several point estimates were above 1.0 and statistical power was limited.
authors.affiliation: aRakai Health Sciences Program, Entebbe, Uganda bJohns Hopkins University, Bloomberg School of Public Health, Baltimore, Maryland, USA cMakerere University School of Public Health dMakerere University College of Health Sciences, Kampala, Uganda.
authors.forename: Tom
authors.initials: T
authors.lastname: Lutalo
authors.forename: Richard
authors.initials: R
authors.lastname: Musoke
authors.forename: Xiangrong
authors.initials: X
authors.lastname: Kong
authors.forename: Fred
authors.initials: F
authors.lastname: Makumbi
authors.forename: David
authors.initials: D
authors.lastname: Serwadda
authors.forename: Fred
authors.initials: F
authors.lastname: Nalugoda
authors.forename: Godfrey
authors.initials: G
authors.lastname: Kigozi
authors.forename: Nelson
authors.initials: N
authors.lastname: Sewankambo
authors.forename: Joseph
authors.initials: J
authors.lastname: Sekasanvu
authors.forename: Maria
authors.initials: M
authors.lastname: Wawer
authors.forename: Ronald
authors.initials: R
authors.lastname: Gray
mesh_terms: D000293:Adolescent; D000328:Adult; D015331:Cohort Studies; D003271:Contraceptive Agents, Female / Q000008:administration & dosage*; D003276:Contraceptives, Oral / Q000008:administration & dosage*; D005191:Family Characteristics; D005260:Female; D015658:HIV Infections / Q000453:epidemiology* / Q000635:transmission*; D006801:Humans; D015994:Incidence; D016912:Levonorgestrel / Q000008:administration & dosage*; D008297:Male; D017258:Medroxyprogesterone Acetate / Q000008:administration & dosage*; D008875:Middle Aged; D012189:Retrospective Studies; D018570:Risk Assessment; D014454:Uganda; D055815:Young Adult
chemical_list: D003271:Contraceptive Agents, Female; D003276:Contraceptives, Oral; D016912:Levonorgestrel; D017258:Medroxyprogesterone Acetate